Evaluation of hair cortisol and cortisone change during pregnancy and the association with self-reported depression, somatization, and stress symptoms

Figures & data

Table 1. Medians of hair cortisol (HCC) and hair cortisone concentrations (HCNC) of the study cohort.

		2nd trimester		3rd trimester
	Sample size	HCC median n = 59 (P25, P75)	HCNC median n = 58 (P25, P75)	HCC median n = 60 (P25, P75)	HCNC median n = 59 (P25, P75)
Study population	n = 62	3.7 (1.4; 5.6)	11.1 (6.9; 16.9)	3.8 (2.6; 6.5)	16.9 (9.5; 22.3)
Maternal nationality	n = 60
German	92%	3.6 (1.4; 5.9)	11.8 (7.5; 17.1)	3.1 (2.6; 6.5)	18.1 (9.5; 22.3)
Other	8%	3.3 (1.3; 4.3)	6.2 (2.6; 6.8)	3.8 (2.4; 6.6)	16.5 (6.1; 30.5)
Maternal education (years)	n = 60
10–11	15%	4.5 (1.9; 8.0)	10.1 (5.3; 13.3)	3.7 (2.4; 5.9)	11.7 (9.8; 34.6)
>11	85%	3.5 (1.3; 5.6)	11.7 (7.3; 17.1)	3.9 (2.6; 6.4)	17.4 (9.9; 22.4)
Socioeconomic status (SES) (Winkler index)	n = 56
Low SES	11%	3.6 (2.3; 5.4)	10.1 (7.7; 13.3)	5.2 (3.8; 6.9)	15.2 (10.5; 21.4)
Middle SES	41%	3.8 (2.3; 5.7)	11.6 (7.4; 14.6)	4.2 (2.3; 8.9)	18.8 (10.1; 24.2)
High SES	48%	3.2 (1.1; 5.5)	9.7 (4.9; 17.1)	3.2 (2.5; 4.4)	14.4 (8.6; 20.6)
Maternal age at delivery (years)	n = 62
≤25	21%	2.4 (1.0; 3.7)	9.4 (7.2; 11.5)	3.4 (2.6; 4.8)	11.0 (7.3; 20.6)
>25 ≤ 30	37%	3.9 (1.8; 7.2)	13.4 (9.0; 17.3)	3.3 (2.0; 5.6)	14.6 (10.1; 21.6)
>30 ≤ 35	27%	4.1 (2.1; 5.6)	11.9 (3.1; 15.8)	4.3 (2.6; 8.5)	18.0 (13.5; 30.5)
>35 ≤ 40	15%	4.7 (2.6; 6.9)	11.5 (7.0; 17.5)	4.7 (3.4; 5.7)	22.3 (16.1; 26.0)
Maternal BMI at first detection of gravidity	n = 60
Underweight	2%	3.6	2.0	0.5	1.9
Normal	82%	3.6 (1.3; 5.7)	11.4 (6.6; 17.0)	3.9 (2.9; 6.6)	17.9 (11.7; 22.5)
Overweight	13%	4.6 (1.6; 5.6)	14.4 (9.4; 18.9)	2.7 (1.9; 4.1)	15.1 (8.1; 22.0)
Obese	3%	2.0 (0.4; –)	6.4 (2.6; –)	1.4	6.2
Smoking during pregnancy	n = 61
No	97%	3.7 (1.6; 5.6)	11.1 (6.9; 16.6)	3.8 (2.5; 6.5)	16.9 (9.2; 22.4)
Yes	3%	4.4 (1.0; –)	13.8 (7.0; –)	2.6 (2.6; –)	15.2 (9.2; –)
PHQ-9 depression scale	n = 52
Minimal (0–4 points)		3.7 (1.6; 6.2)	12.7 (10.1; 17.3)	3.3 (2.2; 5.1)	15.5 (8.5; 21.4)
Mild (5–9 points)		3.2 (1.4; 4.4)	6.3 (3.7; 15.6)	3.3 (2.6; 6.5)	17.9 (9.8; 24.5)
Moderate (10–14 points)		2.5 (1.7; 11.4)	10.7 (8.0; 21.2)	3.7 (3.4; –)	11.7 (7.1; –)

The study cohort is divided in different groups with respective medians of HCC and HCNC for the 2nd and 3rd trimester. Concentrations are given in pg/mg. P25: 25th percentile; P75: 75th percentile.

Figure 1. Distribution and change of hair steroid concentrations during pregnancy. Shown are: (A) ln- transformed hair cortisol (HCC) and cortisone concentration (HCNC) in the 2nd and 3rd trimester (TT) and (B) log₂-fold change of HCC, HCNC, and of the ratio HCNC/HCC from the 2nd to the 3rd TT. (A) is presented as Box-and-Whisker plot (Tukey) with outliers shown as dots. In (B) circles correspond to single individuals and the respective mean is presented as a black line. The actual mean fold increase (2^{log2-fold change}) is stated. Significances were calculated using the paired t-test. n(HCC) = 57; n(HCNC) = 55.

Table 2. Multivariate associations between potential confounders and hair cortisol (HCC) and hair cortisone concentrations (HCNC) and ratio of both steroids (HCNC/HCC).

	2nd trimester			3rd trimester
	HCC (R² = 0.16; minf2 = 0.37)	HCNC (R² = 0.20; minf2 = 0.38)	Ratio (HCNC/HCC) (R² =  0.16, minf2 = 0.39)	HCC (R² = 0.22; minf2 = 0.35)	HCNC (R² = 0.34; minf2 = 0.36)	Ratio (HCNC/HCC) (R² =  0.13; minf2 = 0.36)
	b (95% CI)	b (95% CI)	b (95% CI)	b (95% CI)	b (95% CI)	b (95% CI)
Maternal age at delivery (years)
≤25	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
>25 ≤ 30	0.67 (−0.05; 1.38)	0.06 (−0.46; 0.58)	−0.57 (−1.26; 0.11)	−0.57 (−1.19; 0.05)	−0.29 (−0.94; 0.36)	−0.28 (−0.39; 0.95)
>30 ≤ 35	0.56 (−0.16; 1.28)	−0.04 (−0.57; 0.49)	−0.51 (−1.21; 0.20)	−0.07 (−0.65; 0.52)	0.09 (−0.52; 0.70)	0.16 (−0.47; 0.80)
>35 ≤ 40	0.82 (−0.01; 1.65)	0.01 (−0.50; 0.70)	−0.79 (−1.62; 0.03)	0.18 (0.84; 0.48)	0.04 (-0.64; 0.73)	0.22 (−0.49; 0.93)
Maternal BMI at first detection of gravidity
Underweight & normal	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
Overweight & obese	−0.11 (−0.83; 0.61)	0.01 (−0.54; 0.56)	0.31 (−0.42; 1.04)	−0.17 (−0.73; 0.39)	0.01 (−0.58; 0.59)	0.17 (−0.43; 0.77)
Newborn’s gender
Male	0.16 (−0.35; 0.66)	−0.03 (−0.34; 0.40)	−0.19 (−0.68; 0.31)	−0.13 (−0.55; 0.30)	−0.10 (−0.55; 0.35)	0.02 (−0.44; 0.49)
Female	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
Hair washing
1–3 d/week	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
Every 2nd day	−0.28 (−0.83; 0.27)	−0.42* (−0.81; −0.02)	−0.10 (−0.63; 0.43)	−0.21 (−0.66; 0.25)	−0.27 (−0.73; 0.20)	−0.06 (−0.54; 0.42)
4–6 d/week	0.48 (−0.83; 1.79)	0.43 (−0.52; 1.38)	−0.11 (−1.37; 1.15)	−0.18 (−1.72; 1.36)	−1.30 (−2.88; 0.28)	−1.12 (−2.76; 0.52)
Daily	0.11 (−0.87; 1.09)	−0.57 (−1.37; 0.23)	−1.00 (−2.06; 0.06)	−1.01* (−1.73; −0.28)	−1.38* (−2.19; −0.57)	−0.37 (−1.21; 0.52)
Location of hair sample
Occipital	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
Parietal/temporal	−0.10 (−0.59; 0.39)	−0.09 (−0.45; 0.26)	−0.05 (−0.53; 0.42)	0.18 (−0.29; 0.64)	0.49* (0.02; 0.97)	0.32 (−0.18; 0.81)

Shown are potential confounders of HCC and HCNC and the respective linear regression coefficient (b), 95% confidence interval (95% CI) and reference category in regression model (ref.). R² and minimum detectible effect sizes (min_f2) were added for each model. Steroid concentrations and ratio were ln-transformed. *p ≤ .05. Bold face indicates significant associations.

Figure 2. Significant correlations between hair steroid concentrations and Patient Health Questionnaire (PHQ) subscores. Shown are (A) correlation between HCNC in the 2nd trimester (TT) and the PHQ depression score (PHQ-9), (B) correlation between log₂-fold change of HCNC and the change of the stress score (Δ PHQ-stress score), and (C) correlation between the change of the ratio of HCNC/HCC and the change of the stress score (Δ PHQ-stress score), with respective Spearman correlation coefficient r and corresponding p value. Steroid concentrations were ln-transformed. Circles correspond to single individuals. n = 45.

Table 3. Medians of subscale scores of Patients Health Questionnaire (PHQ) at 2nd and 3rd trimester and median subscale score change.

	n	2nd trimester Score median (P25, P75)	3rd trimester Score median (P25, P75)	3rd trimester – 2nd trimester median of score change (P25, P75)
PHQ- 9 depression scale	52	4.0 (2.0; 6.8)	4.0 (3.0; 7.0)	0.0 (−2.0; 1.8)
PHQ-15 somatization scale	52	7.0 (5.0; 10.0)	8.0 (5.0; 11.8)	1.0 (−2.0; 3.0)
PHQ- stress scale	52	3.0 (1.5; 5.0)	2.0 (1.0; 4.0)	−1.0 (−2.8; 0.0)*

Shown are PHQ-9 as subscale for depression, PHQ-15 as subscale for somatization and PHQ-stress as subscale for stress. P25: 25th percentile; P75: 75th percentile, *Wilcoxon signed-rank test significant at p ≤ .05.